HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: \A(3 0 55G
RECEIVED
Building Permit Application FEB 2 7 2fJ19
Planning and Development Services ST. (aNclQ Caune Permittin
Building and Code Regulation Division y� g
2300 Virginia Avenue,Fort Pierce FL 34982 ✓
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Sa°�
� y;.;�yJ� a � K� -, �.�..int� � Js�rK �♦ �� 7, e Xr 3` 4�, .c t' "� �'yYk 4 Y
n�..w. a. t nPv�. R3���L�l�.'-�,.��_.a�,..��:i�r.,-5�w d,�'F;����':+�'.r' �`ur:''�'...�a„� v�"aS� 4� �....�'S�mT`fiac��'�-`t„"�4`�*T�'�,�. ..+a':.sS�t'�s`�..•�''-�7
Address: -300 IV W Ih M Sp 61Y-6t.
Legal Description: P� ✓2r io4q l� it n;T e p
/3l t/, 3�iaa-
i r-hv 3 yTI d �,� spa =J ';I_Q))
Property Tax ID#: Lot No.��
Site Plan Name: Block No. 139
Project Name:
Setbacks Front Back: Right Side: Left Side:
... :, ...P.. x.�"
MAI .a. at r' .=,c:Y-..%`51. �t y w,
Ea h r^s' i`--✓_'�L-,�/�,ft � �,''xC f x-'�'uh,n'a'x �? Ek+,-5j�.'r-k�, t�,.t� � y.;.c � �!'s ,��.
' ��i�r'•+�i.[i✓ � ;a�Y1������4ti'.
a ..xa""S lilLeFt's", �:3; fsrsu s,.._-:it, ..a�.H-tiJ ?r_ '}z �"4�,h,w;A r....`� w'`�1 :" •Si�.d�,Yi.`-�.�!%t'za H'f`a`,_..�,. ..c?;•->sru...rt - N;+Ff:` :r'ul„ ''a,ra.-"•�'
lqe
"�9, A�.��� �;��5<z� ..s��pr&ar�.�! 4 ,�{,...� �z�•.'s ?�'4 rr k� rag �.,�+ �1^�#� ��• �•
�., (� .yt ` �,•�"_��^j.��P w 8 '�` -s,-�5j1 �ywL. F'}S»lc > yr.��,,,,,'"�'r F3�F�.<.+�-�}'y. �a„�"FP�.,�'�?�c�.'"#Sr�'`�S r, ',�}hC'`'}�
Additional work toe e Orme under this permit—c ec a appy:
HVAC 13 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric El Plumbing Sprinklers E Generator Roof Roof pitch
Total Sq. Ft of Construction: 21'00 S . Ft.of First Floor:
n Q r00
Cost of Construction:$ /(�/J Utilities: Sewer Septic Building Height: l�
x'3 ' sa- +}'. `s �, °qr *' '
�� .. Y��YR� '+iC rt o._+.J"'.' � ..,.M1a�,1� P?.-`�•^ �ki i�h �..
r' �, .��;.a�:,u�.�`:is��...S.a„�. �;3�;�,�a..�• ?u'��e, ��:���,��cr_=�”-�•sr �..�,�—.L=;�r�,-.�: >',�:�. =._a»» �,.z �.' -�'s�:��"�i�'s�:,. ��t,��:
Name 2 Name: S•
Address: ZIDa S S S C1-cleX_' p Company: C
city: d State:_I�Y, Address: M
Zip Code:/.3xS� Fax: City: PSL_ Stake/- AL—
Phone Noll?I� ge) / P oa(o Zip Code: 346 Fax:
E-Mail: Phone No. X)2
Fill in fee simple Title Holder on next page(if different E-Mail: S
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
• E
y,.:L �d"4 ,d�C ek ,?'n xex �}d 4 h 4t" i :.::`rte°3" �'-'Sl'r-0 ,.�'' �`{� }roa+^^�
SUI?�LEMEIvTAI CONSTR'UC,TIGON� IEI�}kLAW INEXX RMATIO,N:F � ,u� ., � �k
Y;�k..-_< :w.;^;: '.u'.'s�. `.�:r..^ms. :,z
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address:. Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the.permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as t for Owner Ignature of Contractor/Lic a Holder
STATE OF FLORIP4STATE OF FLORIDA
COUNTY OF M a COUNTY OF �S • W[ (G!'P�
The for�yo' instr im at as acknowledged efore me The for o�'n�instrur}eawas acknowledge before me
this_/ of ° by' this ay of PC 19M Ail 4A.2 CJby
nc�G �►4' �S'. D n
Name of person making statement / Nameof persgn mak statement
Personally Known OR Produced Identification ✓ Personally Known V OR Produced Identification
Type of Identification /1 p Type of Identification
Produced. S32 3W-0 Produced
(Signature of Notary Public-State of Florida) (Sign of Notary Public-SS/t__ate�offcFlorida)
Commission No.= (Seal) ! l l
Commission No. rf(JiTGI�ZrL; (Seal)
x P(, Notary Public State of Florida o,,hunstate of Florida
? a Jennifer Davis r° Jennifer Davis
REVIEWS o4 �� sizo2 RVI R PLANS VEGETA Ca , ,�EXTURfipgon FI�f�AftR0
C REVIEW REVIE p'O- F€ 11 J2 129 9
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17